Preventing Obesity through Intervention during Infancy

描述(由申请者提供)：这项研究将测试一种预防儿童肥胖的新的早期干预计划的效果。护士将在出生后第一年的三次家访中对首次为人父母的父母及其婴儿进行干预，然后每年访问临床研究中心，直到3岁。国家健康和营养检查调查(NHANES)的数据表明，有必要进行早期干预以预防肥胖：从2007年到2008年，超过10%的2岁以下儿童已经肥胖，超过20%的2岁至5岁儿童超重或肥胖。这些发现令人担忧，因为超重的婴儿和蹒跚学步的儿童以及婴儿发育迅速的人在以后的生活中患肥胖症及其共病的风险更高。此外，预防和治疗年龄较大儿童肥胖的尝试收效甚微。相比之下，婴儿期可能是开始预防肥胖的好时机。这是一个快速生长和发育可塑性的关键时期，具有长期的代谢和行为后果。基于有希望的先导研究结果，并使用生态/发展框架，拟议的研究试图在一项包括儿童安全控制程序的双臂随机试验中提供和测试预防儿童肥胖的计划。肥胖预防计划的重点是从婴儿期到3岁的响应性喂养、喂养责任分工和健康饮食选择的信息。因此，这项干预将教会第一次为人父母的人a)认识到婴儿饥饿和饱足的迹象，并更有选择地只在饥饿时喂食；b)对挑剔但不饿的婴幼儿使用替代的抚慰策略；c)为儿童提供适当比例的健康食物，并允许儿童确定摄入量；以及d)如何通过反复接触蔬菜来提高对适合发育的食物的接受度。这一信息在婴儿出生后的第一年尤其重要，因为婴儿的饮食结构发生了戏剧性的转变，从最初的纯牛奶饮食转变为他们文化中成人饮食的多种食物。在这一过渡期间，随着食物被介绍给儿童，有许多机会解决饮食内容以及父母喂养方式的问题。我们建议调查干预措施对母乳喂养意向和配方奶喂养意向的影响。该干预计划被假设为在母乳喂养和配方奶喂养的婴儿中都显示出疗效，根据3岁时的主要结果--体重指数(BMI)百分位数来衡量。这一结果为长期肥胖风险提供了重要的洞察力。

DESCRIPTION (provided by applicant): This research will test the effects of a novel early intervention program to prevent childhood obesity. Nurses will deliver interventions to first-time parents and their infants at three home visits in the first year after birth followed by annual clinical research center visits until age 3. National Health and Nutrition Examination Survey (NHANES) data demonstrate the need for early intervention to prevent obesity: from 2007 to 2008, over 10 percent of children less than 2 years were already obese and over 20 percent of children between ages 2 and 5 years were overweight or obese. These findings are cause for concern because overweight infants and toddlers and those with rapid infant growth are at increased risk of obesity and its co-morbidities later in life. Further, attempts to prevent and treat obesity with older children have had limited success. In contrast, infancy may be an opportune time to begin obesity prevention. It is a critical period of rapid growth and developmental plasticity with long-lasting metabolic and behavioral consequences. Based on promising pilot study results and using an ecological/developmental framework, the proposed research seeks to deliver and test a program to prevent childhood obesity in a two arm randomized trial that includes a child safety control program. The obesity prevention program focuses on messages of responsive feeding, division of feeding responsibility, and healthy dietary choices that extend from infancy through age 3 years. As such, the intervention will teach first-time parents a) to recognize infant hunger and satiety cues and use feeding more selectively in response only to hunger, b) to use alternative soothing strategies to feeding for the fussy, but non-hungry infant and toddler, c) to provide children with appropriate portions of healthy foods and allow children to determine the amount consumed, and d) how to improve acceptance of developmentally appropriate foods such as vegetables through repeated exposure. This information is especially important during the first year after birth as infants make a dramatic dietary transition from the initial exclusive milk diet to one with many foods of the adult diet of their culture. During this transition, as foods are being introduced to children, there are numerous opportunities to address dietary content as well as parent feeding style. We propose to investigate the impact of our intervention on both intent to breastfeed and intent to formula feed mother-infant dyads. The intervention program is hypothesized to show efficacy in both breast and formula fed infants as measured by the primary outcome, body mass index (BMI) percentile at age 3 years. This outcome provides significant insight into long-term obesity risk.